Arthrofibrosis

Side view of section through a normal knee, where there are no adhesions locking up movement.	Adhesions developing in the suprapatellar pouch, posterior capsule and anterior interval may create flexion loss, extension loss or both.	Matured scar tissue has contracted, closing the important spaces that normally allow movement, and pulling the kneecap right down.

Rehabilitation issues with arthrofibrosis

Early adhesions and later scar tissue form within the joint and soft tissue spaces, and persist despite increasing rehabilitation efforts. Early range of motion problems can be reversed with empathetic management - progressing patellar mobilisation and range of motion exercises in combination with adequate pain relief without pushing the joint into painful inflammation that makes things worse. Manipulation under anaesthesia may help to break adhesions before they become permanent scar tissue. Advanced arthrofibrosis with marked knee stiffness may need surgical lysis of adhesions to regain range of motion, in combination with specialist pain management and physiotherapy.

Arthrofibrosis and patella baja (patella infera)

As the soft tissues behind and below the kneecap (patella) become involved in the scar tissue process, the kneecap may be pulled into an abnormally low position (patella baja) which may result in considerable pain with walking.